@extends('user.base')
@section('content-header','Patient Information')
@section('content-body')
<section  class="content">
	<!--Display detailed patient information-->
	<div class="container col-md-9 col-xs-9">
		<form class="form-horizontal" action="{{ URL('patient/info/'.$patient->id)}}" method="post" accept-charset="utf-8">
			<input type="hidden" name="_token" value="{{ csrf_token()}}">
			<input type="hidden" name="_method" value="PUT">
			<div class="form-group">
				<label class="control-label col-md-4 ">First Name:</label>
				<div class="col-md-6">
					<input class="form-control " type="text" name="firstname" value="{{ $patient->first_name }}" placeholder="Enter patient's' first name here" required="required">
				</div>
			</div>
			<div class="form-group">
				<label class="control-label col-md-4">Last Name:</label>
				<div class="col-md-6">
					<input class="form-control" type="text" name="lastname" value="{{ $patient->last_name}}" placeholder="Enter patient's last name here" required="required">
				</div>
			</div>
			<div class="form-group ">
				<label class="control-label col-md-4">Check No.</label>
				<div class="col-md-6">
					<input class="form-control" type="text" name="checkNumber" value="{{ $patient->check_num }}" placeholder="Enter check no. here.">
				</div>
			</div>
			<div class="form-group">
				<label class="control-label col-md-4">Age:</label>
				<div class="col-md-6">
					<input class="form-control" type="number" name="age" value="{{ $patient->age }}" placeholder="" max="99" mix="0" step="1" required="required">
				</div>
			</div>
			<div class="form-group">
				<label class="control-label col-md-4">Sex:</label>
				@if($patient->sex == 'male')
				<label class="radio-inline">
					<input  id="radioMale" class="" type="radio" name="sex" value="male" placeholder="" checked>
					Male
				</label>
				<label class="radio-inline">
					<input id="radioFemale" class="" type="radio" name="sex" value="female" placeholder="">
					Female
				</label>
				@else
				<label class="radio-inline">
					<input  id="radioMale" class="" type="radio" name="sex" value="male" placeholder="" >
					Male
				</label>
				<label class="radio-inline">
					<input id="radioFemale" class="" type="radio" name="sex" value="female" placeholder="" checked>
					Female
				</label>
				@endif
			</div>
			<div class="form-group">
				<label class="control-label col-md-4">Contact:</label>
				<div class="col-md-6">
					<input class="form-control" type="tel" name="contact" value="{{ $patient->contact_num }}" placeholder="Enter patient contact number here.">
				</div>
			</div>
			<div class="form-group">
				<label class="control-label col-md-4">Address:</label>
				<div class="col-md-6">
					<input type="text" class="form-control" name="address" value="{{ $patient->address }}" placeholder="Enter patient address here.">
				</div>
			</div>
			<div class="form-group">
				<label class="control-label col-md-4">Description:</label>
				<div class="col-md-6">
					<textarea class="form-control" rows="5" placeholder="Brief patient description" name="description">{{ $patient->description }}</textarea>					

				</div>
			</div>
			<div class="form-group">
				<div class="col-md-6 col-md-offset-4">
					<button class="btn btn-success form-control">
						OK
					</button>
				</div>
			</div>
		</form>
	</div>
</section>
@endsection
@section('css')
@endsection
@section('js')
<script type="text/javascript">$(".datepicker").datepicker({
	todayBtn: "linked"
});</script>
@endsection